Enhanced recovery after surgery (ERAS) has become a hot issue around the world [1]. It aims to accelerate patients' recovery after surgery and prioritize the cost-effectiveness of health care. Generally, multiple disciplinary work team is of crucial importance to make an optimized protocol in detail. Also, it is accordance with the top principle of precision medicine in clinical practice. However, micro invasive surgery and shortening length of stay in hospital have been excessive emphasized or over evaluated as a foremost target to seek for, which is pushing some patients into risk of worsing outcomes. Some of patients have to face readmission due to serious postoperative complications or insufficient nutrition due to discharge ahead. Hence, it's time to correct the misunderstanding of ERAS and rethought about it. Obviously, the right understanding of ERAS is of essence to benefit both of surgeons and patients.

Enhanced recovery after surgery; Know-how; Therapy

Authors Propose a Concept of 4-S to Clarify the Truly Implication of ERAS

3.1Survival

Micro invasive surgery really does matter to ERAS, but not be-all, especially for patients with malignancy. Improvement of survival rate should be the top priority of ERAS.

3.2 Safe

Multiple disciplinary team (MDT) aims to provide an accessible protocol to ensure patients' safety perioperation [2]. High-end surgery must be in accordance with operators' experience and their accurate skill. It is not practical to establish a standardized ERAS to meet the demand of different levels of primary clinical settings.

3.3 Save

As we all well known, it’s essential to save total medical cost because of scarce health-care resources. As a result, the length of stay in hospital is shortened because of application of high-end equipments or smart ecosystem including laparoscopic or robotic surgery, mobile smart wrist device, etc. However, smart medical service may also increase the burden of patients’ medical cost or transfer the cost to the provider. How to balance the new emerging techniques and the traditional techniques means save.

3.4 Standardize evaluation system

The days of stay in hospital, total hospitalization cost, postoperative complications, the frequency of reoperation (postoperative time less than 3 months) and/or readmission (less than 1 month after discharge), survival time (more than 6 months), the severity of surgery-related negative emotion, etc play a deciding role in judging /evaluating ERAS whether successful or not. At first glance, no discomfort of pain perioperation and perfect surgery are an important element of ERAS, but on second look, the pain curbed by drugs may hide some truth. As a matter of fact, it is unreliable to predict anything.

No one doubts that smart medical service combined with skillful surgery is bringing ERAS on precision medicine track [2,3]. ERAS is not only a concept, but also of relevance for hospital's management.

1. Lau CS, Chamberlain RS (2016) Enhanced Recovery After Surgery Programs Improve Patient Outcomes and Recovery: A Meta-analysis. World J Surg 1-15.

2. Nelson G, Kiyang LN, Chuck A, Thanh NX, Gramlich LM (2016) Cost impact analysis of Enhanced Recovery After Surgery program implementation in Alberta colon cancer patients. Curr Oncol 23: e221-e227.

3. Sola M, Ramm CJ, Kolarczyk LM, Teeter EG, Yeung M, et al. (2016) Application of a Multidisciplinary Enhanced Recovery After Surgery Pathway to Improve Patient Outcomes After Transcatheter Aortic Valve Implantation. Am J Cardiol 118: 418-423.